Comparison of Hemostatic Effects between a Combination Therapy Including Endoscopic Injection Therapy and Omeprazole and a Single Intravenous Omeprazole Therapy in Patients with Bleeding Peptic Ulcers
Seon Hee Lim, M.D., Nayoung Kim, M.D.* and Kye Heui Lee, M.D.†
Seoul National University Hospital, Healthcare System Gangnam Center, Healthcare Research Institute, Seoul, *Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, †Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
Abstract
Background/Aims: This study was performed to test whether there is some difference between combined endoscopic therapy with PPI infusion and intravenous PPI therapy alone. Methods: A total of seventy-three high-risk patients with ulcer bleeding and non-bleeding visible vessels or fresh adherent clots resistant to irrigation were randomized to medical therapy [intravenous omeprazole therapy alone: 40 mg IV per day for 3∼5 days] or to endoscopic combination therapy [endoscopic epinephrine (1：10,000 in normal saline) or ethanol injection followed by intravenous omeprazole infusion]. Results: Patients were similar at study entry. Ulcer bleeding recurred in two patients who received combined endoscopic therapy (2/35, 5.7%) while ulcer bleeding recurred in ten patients who received intravenous omeprazole alone (10/38, 26.3%) (p＜0.05). Two patients (2/35, 5.7%) in the combined therapy group and five patients (5/38, 13.2%) in the omeprazole infusion alone group had surgery for intractable bleeding (p=0.281). One patient in each group died within the hospital stays (p=0.953). Conclusions: The combination of endoscopic injection therapy with omeprazole infusion is superior to omeprazole infusion alone for preventing recurrent bleeding from ulcers with nonbleeding visible vessels or adherent clots. (Korean J Gastrointest Endosc 2005;31:221228)
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